目的 探討杏芎氯化鈉注射液聯(lián)合硫酸氫氯吡格雷片治療腦梗死臨床療效。方法 選取2018年10月-2019年4月在延安大學(xué)咸陽(yáng)醫(yī)院治療的腦梗死患者206例，根據(jù)用藥的差別分為對(duì)照組（103例）和治療組（103例）。對(duì)照組口服硫酸氫氯吡格雷片，75 mg/次，1次/d；治療組在對(duì)照組基礎(chǔ)上靜脈滴注杏芎氯化鈉注射液，100 mL/次，1次/d。兩組患者均治療15 d。觀察兩組患者臨床療效，同時(shí)比較治療前后兩組患者NIHSS評(píng)分、mRS評(píng)分、ESRS評(píng)分、SPI-Ⅱ評(píng)分、ADL評(píng)分、腦血流動(dòng)力學(xué)，血清C反應(yīng)蛋白（CPP）、白細(xì)胞介素-17（IL-17）、CXC趨化因子配體12（CXCL12）、白細(xì)胞介素-23（IL-23）、單核細(xì)胞趨化蛋白-1（MCP-1）和可溶性血管細(xì)胞黏附因子-1（sVCAM-1）水平，及血管儲(chǔ)備功能（CVR），屏氣指數(shù)（BHI）、纖維蛋白原（FIB）、全血低切黏度（LBV）、全血高切黏度（HBV）、血漿黏度（SV）和血小板聚集率（PAR）。結(jié)果 治療后，對(duì)照組和治療組臨床有效率分別為82.52%和97.09%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者NIHSS評(píng)分、mRS評(píng)分、ESRS評(píng)分和SPI-Ⅱ評(píng)分顯著下降（P<0.05），而ADL評(píng)分顯著升高（P<0.05），且治療組患者這些評(píng)分項(xiàng)目明顯好于對(duì)照組（P<0.05）。治療后，兩組患者血清CPP、IL-17、CXCL12、IL-23、MCP-1、sVCAM-1水平均顯著下降（P<0.05），且治療組比對(duì)照組下降更明顯（P<0.05）。治療后，兩組雙側(cè)大腦動(dòng)脈Vp、Vm均顯著升高（P<0.05），DVp和DVm顯著降低（P<0.05），且治療組改善程度最明顯（P<0.05）。治療后，兩組患者CVR、BHI均明顯升高（P<0.05），且以治療組比對(duì)照組升高更顯著（P<0.05）。治療后，兩組患者FIB、LBV、HBV、SV、PAR水平均顯著降低（P<0.05），且治療組這些血液流變學(xué)指標(biāo)水平明顯低于對(duì)照組（P<0.05）。結(jié)論 杏芎氯化鈉注射液聯(lián)合硫酸氫氯吡格雷片治療腦梗死有利于促進(jìn)患者腦神經(jīng)功能恢復(fù)，提高患者生活質(zhì)量、日常活動(dòng)能力和降低腦血管事件發(fā)生風(fēng)險(xiǎn)。

Objective To investigate the clinical effect of Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection combined with clopidogrel in treatment of ischemic cerebral infarction. Methods Patients (206 cases) with ischemic cerebral infarction in Xianyang Hospital of Yan'an University from October 2018 to April 2019 were divided into control (60 cases) and treatment (60 cases) groups based on different treatments. Patients in the control group were po administered with Clopidogrel Hydrogen Sulphate Tablets, 75 mg/time, once daily. Patients in the treatment group were iv administered with Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection on the basis of the control group, 100 mL/time, once daily. Patients in two groups were treated for 15 d. After treatment, the clinical efficacy was evaluated, and the NIHSS scores, mRS scores, ESRS scores, SPI-Ⅱ scores, ADL scores, cerebral hemodynamic, the serum levels of CPP, IL-17, CXCL12, IL-23, MCP-1, sVCAM-1, and CVR, BHI, FIB, LBV, HBV, SV and PAR in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the controland treatment groups was 82.52% and 97.09%, respectively, and there were differences between two groups (P<0.05). After treatment, the NIHSS scores, mRS scores, ESRS scores, and SPI-Ⅱ scores in two groups were significantly decreased (P<0.05), but the ADL scores were significantly increased (P<0.05), and these scores in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the serum levels of CPP, IL-17, CXCL12, IL-23, MCP-1, and sVCAM-1 in two groups were significantly decreased (P<0.05), and these serological indexes in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the Vp and Vm of bilateral cerebral arteries in two groups were significantly increased (P<0.05), but the value of DVp and DVm was significantly decreased (P<0.05), and the hemodynamic parameters in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the CVR and BHI in two groups were significantly increased (P<0.05), and which in the treatment group were significantly higher than those in the control group (P<0.05). After treatment, the FIB, LBV, HBV, SV, and PAR levels in two groups were significantly decreased (P<0.05), and these indexes in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection combined with clopidogrel in treatment of ischemic cerebral infarction is beneficial to promote the recovery of cerebral nerve function, improve the quality of life, daily activity ability and reducing the risk of cerebrovascular events.

R971

陜西省科學(xué)技術(shù)廳研究項(xiàng)目（2017SF-282）